visa.gif (2889 bytes)  Mastercard.gif (1502 bytes) amex.gif (958 bytes)

ACKNOWLEDGEMENT OF CARD BILLING

I, …Pedro Vargas………………, Have authorized the "( Merchant )"

" CISE ELECTRONICS CORPORATION " , to charge my …VISA…in the

amount of……Doscientos dolares ////..................………....................

$ …200.-….US dollars, for goods and / or services specifically descripted

as : Reserva de vacante Curso Intensivo Inyeccion Electronica Nivel I

para extranjeros America Latina
con fecha de comienzo 01-02-04....


My card number are: 8500 3245 1343 6789

Exp. Date ( MM/YY)…12/12…….

CVV2/CVC2/CID number:.337.....



My name as it appears on my card is ..Pedro Vargas..……………..……

The billing address for my card is:  Calle 23 numero 456, Concorida, Prov. de Yucatan, Ecuador.
                                 Domicilio donde se recibe el resumen de cuentas de su tarjeta

State/Province...Yucatan............Country......ECUADOR................................

Phone:...593 5 678909.......................

               Firma
Sign Here……………………..............Date ……8 de Febrero .....2010.
               (Cardholder)

Send by Fax to: Cise Electronics Corp.
Fax number: 786 293 1076


VOLVER